I couple of weeks ago I mentioned that I was checking out UW’s mental health clinic, mainly because I wanted to facepalm at the Traditional Chinese Medicine/acupuncturist screener. I wanted to explain why I was going, for two main reasons:

1. I don’t want people to worry about me, especially since it’s not that bad. I know I concerned a lot of people, including some who emailed me personally, so I wanted to let them know I was okay.
2. Mental health has a lot of stigma attached to it because people are so embarrassed to admit anything is wrong. And frankly, it’s silly. We don’t tease or shame people for having bronchitis or cystic fibrosis or other physical ailments. And hell, mental health is still physical – the brain is an organ, not some disembodied spiritual puppet master. If we don’t mock people for being deficient in insulin, we shouldn’t mock them for being deficient in serotonin.

I was especially motivated by JT Eberhard’s bravery in so openly discussing his struggles with anorexia on his blog. So I want to do my part in breaking down that stigma, and talk about why I was going.

I don’t pick on myself. I pick at myself.

Dermatillomania, Compulsive Skin Picking, BFRB (Body-focused Repetitive Behavior). There are a lot of names for it, mainly because it’s only recently being recognized, and no one knows quite how to categorize it. It’s part of the Obsessive-Compulsive Disorder Spectrum along with classical OCD, anorexia, body dysmorphic disorder, hypochondria, and Tourette’s. It’s very closely related to the more well known trichotillomania, which is compulsive hair pulling. But instead of plucking hairs, I peel at the skin on my fingertips and lips.

It was weird when I finally realized there was a term for what I’ve been doing since I was a little kid. But it was even weirder when I read the description of the disorder. It was like a stranger has been secretly spying on me when I read this article:

What I am referring to is not the kind of little bits of rough nail or cuticle that everyone picks at or bites from time to time, nor is it the occasional blemish that people might squeeze or pick. These nail-biters continually bite their nails past the nail bed and their cuticles until they bleed and are constantly walking around with red, sore, and sometimes infected fingers. Those who pick their skin compulsively have their faces and bodies covered, at times, with red sores and scabs known as acne excoria, a self-inflicted skin disorder that resembles acne. The smallest pimple or blemish must be opened and picked at or squeezed, either with the fingers or another implement such as tweezers, needles, pins, toothpicks, etc. Numerous scars are often the result.

It’s funny. These particular examples sound gross and extreme to me because they’re not my particular tick. But what’s become normal for me is probably bizarre to all of you. I pick at the skin on the pads of my thumbs and fingers, and at my lips. It starts with a bit of dead skin that many people would pick off. But my problem is I can’t stop. You know how little kids like to put glue on their hands, let it dry, and then peel it all off? It’s the same fun – except I’m pulling off skin that’s not ready to come off.

Sometimes I go too deep, or go too far, and I’ll bleed. The result is bright red, scarred thumbs that look miserable and hurt to bend, or bruised and chapped lips that I perpetually blame on the weather. It’s clear that it’s a compulsion. You’d think the first time I made myself bleed I’d stop, right? But I’ve done it probably hundreds of times, and most of the time I can’t even stop while I’m bleeding – the job has to be “finished” until everything that can be removed is.

Why? The article gets it right again:

Another similarity between these problems and trichotillomania is that they seem to happen when people are in one of two modes. Some do it in an automatic way, as if they are in a trance and not really thinking about what they are doing. Usually, they are involved in some other activity at the same time such as reading, talking on the phone, working at the computer, watching TV, etc. For others, the deliberate picking or biting is their main activity at the time, and they will frequently interrupt other activities to engage in it.

There is also a strong commonality seen in the various purposes behind these three problems. At the most basic level, they satisfy an urge. Many report an almost uncontrollable feeling of needing to do them. Pulling, picking or biting also seem to deliver a pleasurable or relaxed sensation. When sufferers feel stressed, doing these things has a kind of soothing effect on their nervous systems, and reduces levels of stimulation. On the other hand, when they are bored or inactive, they seems to provide a needed level of stimulation to the nervous system. This probably accounts for why so many people who dislike doing them find it so hard to stop. It simply “feels good” at the time, no matter what the consequences.

If I’m stressed, I pick. If I’m bored, I pick. Sometimes I don’t even realize I was doing it until the damage is done. And worse, sometimes I realize I’m doing it, and my mind is screaming “Just stop!” and I can’t.

And as time goes by, it gets worse. Not in intensity, but in scope. The more I peel, the more the skin around the edge gets weak – so I then have more stuff to peel in the future. Which means what used to be a little pink spot near my thumbnail has crawled almost to the base of my thumb.

So that’s why I went to get help. I want to stop before my whole hand is a scarred mess, or before I take a chunk out of my lips that won’t grow back. I wanted to stop feeling ashamed when people asked what was wrong with my thumb (A paper cut? A blister? A skin disorder? Who was I kidding?). I wanted to stop freaking out about someone noticing it in a photo or when I shook their hand.

But I couldn’t do it with willpower alone. And I couldn’t do it with friends yelling at me to stop – that just made me feel even more terrible, which ironically would make me pick more. Though I did find a trick to stop picking at my nails – I cut them very short. Forgetting to bring nail clippers on a speaking trip is a tragedy for me.

But an unexpected upside to all of this? I get to geek out about the science behind it.

I know, always the nerd. But it’s intriguing. There’s a good sign this is genetic, which is also true in my family. And the hypotheses behind it are interesting:

Some have theorized that there may be that the same out-of-control grooming mechanism in the brain underlies them all. My own theory is that there may be some type of dysfunction of a brain mechanism that regulates levels of stimulation within the central nervous system, and that these behaviors represent an attempt to control these internal stimulation levels externally. People seem to pull, pick, or bite when they are either overstimulated (due to stress or excitement) or understimulated (due to boredom or inactivity). Many similar behaviors can be observed in animals who are kept in confined or unstimulating environments, or who live in stressful conditions.

The latter theory is supported by the fact that anti-depressants often successfully treat dermatillomania, though little research has been done on it yet. But if anyone ever wants a genetic sample, they know were to find me.

So, that’s that. I’ve always been wary of putting something out there that people can use as ammunition to show how crazy I am (or atheists are, or feminists are, or evolutionists are, or…). But it’s worth putting it out there to make all the other “crazy” people realize they’re not alone.

And come on. If someone wanted to call me crazy, they already have plenty of wacky things I’ve said or done.